US health care is governed by the payers. This includes insurance companies, managed care companies and the US government. An elaborate labyrinth exists to fund hospital and outpatient health care.
The standards of care have been established and funded largely by pharmaceutical companies. Total National Health Care spending (NHE) grew to 4.5 trillion in 2002 (17.3%) GDP. Very little of that 4.5 trillion has been invested in natural health/integrative medicine strategies. Yet with the advent of Functional Medicine and other Integrative Medicine doctors, innovative options exist to truly help people heal.
We need research dollars invested in such innovative models. Essentially we need new standards of care in health care. We need NIH reform, we need FDA reform. Today according to the Food, Drug, Cosmetic Act, only a drug can claim to cure, treat or mitigate disease. Any non-drug claim is heavily censored and penalized. This must change if we are going to evolve into an era of real health reform.
Anything less is shuffling the chairs on the titanic as health care spending will eclipse the national budget before long. And a new model will help people get healthy and stay healthy.
Why are insurance companies involved in providing health care in the first place? We have a tightly government-controlled process of making physicians who do not have time in the current model for professional development. They are lobbied by Big Pharma to provide their solutions to the patients. Research is neither independent, nor is comprehensive, and even less replicating results of other researchers, including trial studies.
While division of labor has its use, it has been implemented to divorce theory from practice, with insufficient feedback loops between practitioners and researchers. There are no incentives for practitionersâ ongoing evaluations of the treatments they are trained to prescribe to their patients that can be analyzed comprehensively for long-term efficacy and side effects. We donât understand well what healthy aging means and how to support lifestyles that maximize human health, piling the responsibility on an individual to figure out a course of action from competing narratives we do not check for accuracy and hold people accountable for continuing to propagate regardless of the evidence.
For starters, wouldnât paying physicians good salaries without the insurance industry save money on healthcare?
Actually the managed care companies determine what is paid for. Most often it is a retired nurse on the line who ârecommendsâ certain treatment strategies including medication. The entire system is broken. It will take leaders like RFK Jr and people of like mind who will restore health to the people. The idea of paying doctors a salary has merit, but the standards need to come first. From my experience when money is involved people line up, but there are doctors who have dedicated their lives to rectifying the wrongs who should serve as leaders for building a new system. Many of these doctors have been deplatformed, some hit with huge fines and jail sentences as tragic as that is. Insurance companies have made health care âa businessâ and the business model has failed. The evidence: US health scores which are dismal.
Also reform needs to take place in the research community as well. Billions of dollars of funding goes to pharma based products because of the âprofitâ motive on the back end.
So how do we fund real health and prevention?
This blog is a sound start.
https://www.verywellhealth.com/standard-of-care-2615208
This is a good summary of todayâs health care standards of care.
There are a lot of agencies and it is going to take real leadership to shift these standards.
I live in Italy and, for Italians, healthcare is not a privilege but a right. The fundamental principles of the Italian National Health Service (SSN) are universality, equality and equity. It means the extension of healthcare services to all people. The SSN is structured on three different levels: the first concerns the central government, the second the twenty regional governments and the third the local companies (ASL) with independent hospitals (IHS). EU citizens who work and their dependents are entitled to free healthcare registration, as well as non-EU citizens with special residence permits. SSN is a right of all Italians and is free for the user. The service is financed by a national fund for healthcare. The amount is decided annually by the government. Healthcare contributions are an important source of funding. The United States should apply a large part of the Italian SSN in its health service, because every citizen has the right to free and public healthcare.
Its a good idea but until the corruption is cleaned out in this country it would not work, they have wanted single payer health care for some time but that means the same corrupt lobbies, the same medications and the same draconian standards of care which need to end once and for all; am very encouraged about this public policy site
Agreed! And ⌠in the US, the government is more of a corporatocracy than anything else. While Medicare for All is bandied about here, people forget that Medicare itself has massive limitations and issues, and doesnât necessarily save lives. Apparently the original concept was Expanded and Improved Medicare for All. Once that was shortened to M4A, it helped further the generational divide: why do OLD people get medical care for free/ that we canât get? (Reality: we donât; Medicare is broken.)
In the US, weâre going to need to formulate a step-by-step plan to work toward what Italy has, while ensuring ours might work. Interestingly about a decade ago I was talking with other vendors at the local farmersâ market (west-central Illinois) about single-payer, and many of them were more concerned with âlazy people who wonât workâ getting something for nothing, at the same time lamenting they went without necessary medications often because they were too expensive. Meaning another thing on that list is the undoing of the massive propaganda weâve internalized here!
Proposed Law: Enhanced SNAP Eligibility for Working Single Mothers
Objective:
To provide greater food security for single mothers who are employed by increasing the income eligibility threshold for SNAP benefits.
Key Provisions:
- Increased Income Threshold:
Current Threshold: The current maximum gross monthly income for a household of one is approximately $1,580]
Proposed Change: Raise the threshold to 200% of the federal poverty level (FPL) for single mothers, which would be around $2000 per month for a single-person household
- Work Incentives:
Earnings Disregard: Allow a portion of earned income to be disregarded when calculating eligibility, encouraging single mothers to work without losing benefits.
Childcare Support: Provide additional deductions for childcare expenses, recognizing the significant cost burden on working single mothers.
4. Simplified Application Process:
Streamlined Documentation: Reduce the paperwork required for single mothers to apply for SNAP benefits, making the process more accessible.
Online and In-Person Support: Offer comprehensive support through both online platforms and in-person assistance to help single mothers navigate the application process.
5. Education and Employment Support:
Job Training Programs: Offer job training and educational programs to help single mothers improve their employment prospects and income potential.
Work Requirement Flexibility: Provide exemptions or flexible work requirements for single mothers who are pursuing education or job training.
6. Periodic Review and Adjustment:
Annual Review: Conduct an annual review of the income thresholds and deductions to ensure they remain aligned with the cost of living and inflation rates.
Feedback Mechanism: Establish a feedback mechanism for beneficiaries to provide input on the policyâs effectiveness and areas for improvement.
Implementation Plan:
- **Legislative Approval:
Work with state and federal legislators to draft and pass the necessary amendments to the SNAP eligibility criteria. - Public Awareness Campaign:
Launch a campaign to inform single mothers about the new eligibility criteria and how to apply for benefits. - Partnerships:
Collaborate with local organizations, non-profits, and community centers to provide outreach and support services.
By implementing these changes, the law aims to provide better support for working single mothers, ensuring they have access to the nutrition they need for themselves and their children.
Sweden: Social Assistance and Child Allowance
Swedenâs social assistance program provides financial support to families in need, including single mothers. The child allowance is a universal benefit provided to all families with children, regardless of income. This ensures that all children have access to basic needs, and additional support is available for low-income families.
Being a single mother myself with two children it can be hard. I am a supervisor for company make a salery and barely making it. When prices increased I tried to get assistance like medical and food stamps through the federal government in Ohio. They told me that I make $200 dollars too much to get any assistance.
I know so many people who get paid under the table or do not work at all to take advantage of medical, housing, and food assistance. They get hundreds of dollars in food stamps, free medical, and free housing as well as all their utility payments paid.
I was told by my local job and family services that being a single mother its better to not work at all. This is actually what they are telling people so they can get help.
We need some kind of program that helps single mothers and single fathers who actually have a job. We should have some kind of program where you have to work to get assistance. Not working makes it so much easier for people to not want to work.
Single parents really do not have the ability to get help like most people do if they work.
We should be incentivizing preventative care, with an implementation of baseline level metrics (blood work, etc) similar to a concussion baseline test. Knowing how to address and evaluate change over time. Also, what about pieces like parasites?
Thank you, absolutely! We will need to tap into doctors that understand prevention including naturopaths
In todayâs health care system, prevention is not even discussed
Also the attitudes are terrible when you discuss preventative care
If you discussed parasites you might be laughed at as sorry as that sounds
But that is why we are here, all this needs to change
I am NOT suggesting Socialized Medicine - BUT there needs to be (Forgive me for saying it this way) More regulation as to the charges for EVERYTHING. There should be NO difference in services based on geographical location. Addressing a broken bone in New York, Florida, Iowa or California should be the same. Pharmaceutical companies have Much of their research done at Universities by Tuition paying students or Interns. So the costs should reflect that Lower Cost research. DRUGS, especially Prescription Drugs, should NOT be advertised on T.V. PERIOD. The discussion of drugs, and side effects should be between a Doctor and Patient. Those 30 second to 60 second commercials cost big dollars and those costs are added to the Drug cost the Insurance company, or in some cases the patient just pays. Which by the way increases costs of Insurances. I am NOT opposed to a profit for ANYONE, as long as it is a FAIR Profit, for a FAIR Product. If that profit is based on the efforts done by the Lobbyists, or questionable hidden garbage, then it is WRONG. AND - IF a Drug as advertised on T.V. can lead to DEATH, as many are, that drug should be taken OFF THE MARKET and most definitely off T.V⌠If KNOWN DEATH and is still allowed is unacceptable. In my career, I worked on airplanes owned by doctors and elites. IF I misdiagnosed a problem on their beloved airplane, they refused to pay the bill, and the subsequent work was for free. (a.k.a. a Warranty). WHY is that NOT an option for a Drug company or a doctor? (If the problem is not fixed, there is NO WARRANTY on the services or the product to rely on - Subsequent visits result in Additional Medical Costs) BEFORE you even see a doctor, the question asked is - How are you paying for this? Such Corruption in an industry where the patient is literally held hostage.
- Simplified Plan Choices: One of the most challenging aspects of Medicare is the variety of plans available, especially for Medicare Advantage (Part C) and prescription drug plans (Part D). Offering fewer, more straightforward options could make it easier for people to understand what they need. For example, offering a more standardized benefit package with clearly defined costs and coverage could reduce confusion.
- Clearer Enrollment Process: The current enrollment process can be overwhelming. Streamlining this, perhaps through a simple online tool or a personalized assistance service, could help beneficiaries know when and how to enroll in the right plan for their health and financial needs. A clearer, automatic enrollment process could ensure no one falls through the cracks.
- Increased Outreach and Education: Providing easily understandable educational materials in multiple formats (videos, brochures, in-person or phone help) would help seniors make informed decisions. Community-based outreach, perhaps through senior centers or trusted organizations, could also bridge the knowledge gap.
- Support for Caregivers: Many seniors rely on caregivers for help navigating healthcare and insurance decisions. Providing support for caregivers in understanding and managing Medicare could ease the burden for both seniors and their caregivers.
- More Transparent Costs: One of the most frustrating parts of Medicare is the hidden costs associated with plans and services. Reforming Medicare to offer clearer, upfront information about out-of-pocket costs and avoiding surprise medical bills would help older adults manage their finances and healthcare needs better.
*** Strengthen Patient-Centered Care
Medicare should emphasize a model that prioritizes the patientâs health needs and preferences over the insurance companyâs financial interests. This could include:
- Guaranteed Access to Necessary Care: Ensuring that seniors receive access to the treatments and services their doctors recommend, without insurance companies blocking or limiting coverage.
- More Control for Providers: Allowing doctors to have a greater say in treatment decisions, rather than insurance companies dictating care plans based on cost considerations. This could be achieved by limiting the ability of insurers to deny necessary services or medications.
From what I understand, application for Medicaid requires a lawyerâs involvement costing $10Kâs to make happen. Would it make sense to add to your bullet list, the simplification/streamlining the application for both Medicaid and Medicare, such that a lawyer is not needed to do either?
Billions of Medicare $ going out of country.
Scammers who robocall people and get $150 out of Medicare to review Medicare supplements. They get $650 if they talk The person into changing plans. This is money thatâs just sent abroad to Africa or wherever the scammer is. Money thatâs not spent on health Care money that just goes out of the country. The licensed insurance agents should be in the United States and of good standing not robocall scammers.
Walgreens Medicare department is in India
OptumRx customer service is in the Philippines
On and on and on.
Medicare dollars being spent on administrative costs not healthcare of the citizens.
Dozens and dozens of insurance companies all with infrastructure
Thank you, the current health care system is so cumbersome and convoluted it is virtually impossible to keep up with all the details
Your post is greatly appreciated
Am hoping people with authority to change the health care system read these posts carefully
Instead of paying Medicare dollars to licensed insurance agents in other countries to review our recipients plans and suggest changes and then Bill Medicare for that service. Those services can be done for free by MMAP, Medicare Medicaid assistance program volunteers, that are trained to assist here in the US. Programs already established.
Multiple payers. Multiple health plans, multiple HMOs and PBMs all grab a piece of the pie before a single patient is treated. Healthcare infrastructure costs money. The dreaded âsingle payerâ discussion is a prime target for DOGE. Stop the waste⌠youâve got an ally across the aisle. Work with Bernie Sanders. Get buy in. Right even consider a basic health plan for all. He would assist in that. Guaranteed it would cost less than monstrosity we have now.